Form Ga-V - Withholding Tax Payment Voucher Use Only For Year Indicated
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1*GA-V
*2000001011*
MAIL TO
2000001011
Georgia Department of Revenue
P.O. BOX 740387 - ATLANTA, GEORGIA 30374-0387
TELEPHONE NO. (404) 656-4181
WITHHOLDING TAX PAYMENT VOUCHER
USE ONLY FOR YEAR INDICATED
GA WITHHOLDING NUMBER
FEI NUMBER
TAX PERIOD
DUE DATE
ENTER PAYMENT AMOUNT
NAME and ADDRESS
SIGNATURE
TITLE
TELEPHONE
DATE
DEPARTMENT USE ONLY
*2000001011*
*GA-V
MAIL TO
2000001011
Georgia Department of Revenue
P.O. BOX 740387 - ATLANTA, GEORGIA 30374-0387
TELEPHONE NO. (404) 656-4181
WITHHOLDING TAX PAYMENT VOUCHER
USE ONLY FOR YEAR INDICATED
GA WITHHOLDING NUMBER
FEI NUMBER
TAX PERIOD
DUE DATE
ENTER PAYMENT AMOUNT
NAME and ADDRESS
SIGNATURE
TITLE
TELEPHONE
DATE
DEPARTMENT USE ONLY
*GA-V
*2000001011*
MAIL TO
2000001011
Georgia Department of Revenue
P.O. BOX 740387 - ATLANTA, GEORGIA 30374-0387
TELEPHONE NO. (404) 656-4181
WITHHOLDING TAX PAYMENT VOUCHER
USE ONLY FOR YEAR INDICATED
GA WITHHOLDING NUMBER
FEI NUMBER
TAX PERIOD
DUE DATE
ENTER PAYMENT AMOUNT
NAME and ADDRESS
SIGNATURE
TITLE
TELEPHONE
DATE
DEPARTMENT USE ONLY
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